Irritability, emotional apathy, and positive emotional reactivity are differentially associated with two directions of occupational gaps in the first year after stroke

Background Occupational gaps are discrepancies between activities people perform and those they want to perform. They can occur in opposite directions: Wanted–not performed and Performed–not wanted. It remains unclear whether these directions are associated differently with cognitive-executive, motivational, and affective-emotional characteristics after stroke. Objective To examine which characteristics are associated with each discrepancy direction, whether associations differ between directions, and which characteristics remain independently associated when considered simultaneously during the first year after stroke. Methods This secondary longitudinal analysis included 70 adults with ischemic or hemorrhagic stroke assessed within the first month and at approximately 6 and 12 months, yielding 178 participant-wave observations. Six principal correlates were examined: irritability, emotional apathy, initiation apathy, everyday cognitive-executive difficulties, depressive symptoms, and positive emotional reactivity. Negative-binomial generalized estimating equations were adjusted for assessment wave, concurrent functional dependency, age, education, and baseline stroke severity. Direct discrepancy-direction × correlate comparisons used Holm correction; combined models included all six correlates simultaneously. Complementary analyses decomposed associations into between- and within-person components. Results None of the six principal correlates was associated with Wanted–not performed gaps after Holm correction. Performed–not wanted gaps were positively associated with irritability, emotional apathy, initiation apathy, and everyday cognitive-executive difficulties and inversely associated with positive emotional reactivity. Direct comparisons supported stronger associations with Performed–not wanted gaps for irritability, emotional apathy, initiation apathy, and positive emotional reactivity. In the combined model, irritability (incidence rate ratio [IRR] = 2.05, 95% confidence interval [CI] 1.55–2.71), emotional apathy (IRR = 1.26, 95% CI 1.08–1.47), and positive emotional reactivity (IRR = 0.69, 95% CI 0.54–0.87) remained independently associated with Performed–not wanted gaps. Irritability was associated both between and within persons, whereas the independent emotional-apathy association was most clearly detected within persons. Conclusion The two discrepancy directions showed different patterns of association during the first year after stroke. Distinguishing whether an occupation is wanted but not performed or performed but no longer wanted may provide information relevant to clinical assessment of the alignment between occupational performance and current preference after stroke.